Basic Information
| Provider Information | |||||||||
| NPI: | 1306203559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLTL | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Credential: | M.A. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16600 W SPRAGUE RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441306318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162277700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26376 JOHN RD | ||||||||
| Address2: | |||||||||
| City: | OLMSTED TWP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441381277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402357100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 01/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP.11496 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.